climate finance
The summit unlocked billions in new climate finance but failed to address spiralling the debt levels and high borrowing costs handicapping green transition efforts in developing countries.

An international summit in Paris to debate reforms of the global financial system to meet the threat of climate change was billed by UN Secretary-General Antonio Guterres as a chance for “a new Bretton Woods moment”. It was, he said, an opportunity for “governments to come together, re-examine and re-configure the global financial architecture for the 21st century”.

The Bretton Woods institutions, the World Bank and International Monetary Fund (IMF), will celebrate their eightieth birthday this year. Erected to help countries rebuild after the devastation wrought by World War II, the multilateral development banks are central cogs in a system of international finance that is increasingly viewed as unable or unwilling to address the threat of climate change by global leaders.

“Consider this: over three-quarters of today’s countries were not present at the creation of the Bretton Woods institutions … It essentially reflects, even with some changes, the political and economic power dynamics of that time,” Guterres said in his opening remarks to the delegates in Paris. “Nearly 80 years later, the global financial architecture is outdated, dysfunctional and unjust. There will be no serious solution to this crisis without serious reforms.”

In a letter published ahead of the summit, 13 world leaders, including Joe Biden, Rishi Sunak, Olaf Schulz, and Ursula von der Leyen, described the meeting as a “decisive political moment” to “forge a new consensus” on global development finance.

The Summit for a New Global Financing pact, co-hosted by French President Emmanual Macron and Barbados Prime Minister Mia Mottley in Paris last week, did not reinvent the global financial system. But it did notch several long-awaited wins on the climate finance front, leaving many delegates with a sense of optimism often absent from climate finance negotiations.

The World Bank announced it will allow countries struck by natural disasters to pause debt repayments, but only for new loans. This financial breathing room in the wake of floods, droughts and storms meets a key demand set out by Mottley in the Bridgetown Initiative – a set of development finance reforms first presented at the UN climate summit in Egypt last year that provided the impetus for Macron to host the Paris summit.

On the climate finance front, an additional $100 billion will be made available to climate-vulnerable countries through the IMF’s special drawing rights instrument (SDR), a reserve currency. The SDR funding is separate from the historic loss and damage fund agreed upon at COP27 to finance climate adaptation efforts in low- and middle-income countries, which is expected to be finalized at COP28 in Dubai later this year.

In another first, the outcome statement said the World Bank and IMF would unlock an additional $200 billion in “lending capacity” over the next ten years, subsidized by new investment by rich countries.

The conference statement also mentions the prospect of finding “new avenues for international taxation”, reflecting momentum built on the sidelines of the summit for a tax on international shipping to fund climate efforts. This tax will be debated at the International Martime Organization meetings next month.

Discussions on additional international levies to fund climate adaptation – such as taxes on wealth, aviation, and fossil fuels – remained sharply divisive.

Bringing billions to a trillion-dollar fight

Climate activist Greta Thunberg criticized the summit for failing to address fossil fuels. “If your house is on fire, the first thing you do is to stop pouring oil and gas onto the fire,” she said.

Climate finance, however, is an endeavour requiring trillions, not billions, of dollars.

Ahead of the Paris Summit, the International Energy Agency warned that investments in clean energy in developing countries need to triple from $770 billion in 2022 to nearly $3 trillion by the first half of the 2030s to meet climate targets. A joint report by the United Kingdom and Egypt published ahead of last year’s UN climate summit, meanwhile, found developing countries require an estimated $2.4 billion to cut emissions and build resilience to climate change.

Developed countries said at the Paris summit that they will likely pass the $100 billion climate finance pledge for the first time this year. The pledge, first agreed in 2009, was supposed to be met by 2020, and the accuracy of the figures provided by rich countries are disputed.

Earlier this month, Oxfam’s Climate Finance Shadow Report found that while donor countries claimed to provide $83.3 billion in 2020, “the real value of their spending was – at most – $24.5 billion”.

“The actual support they provide is much less than reported numbers suggest, and is coming mostly as debt that has to be repaid,” said Oxfam. “By providing loans rather than grants, these funds are even potentially harming rather than helping local communities, as they add to the debt burdens of already heavily indebted countries — even more so in this time of rising interest rates.”

The Oxfam findings spotlight the elephant in the conference room of the otherwise successful summit: debt.

The tightening financial conditions resulting from the efforts of central banks to tame inflation amid the array of recent shocks to the global economy – from the pandemic’s disruption of global supply chains to soaring energy and food prices following Russia’s invasion of Ukraine – have hit financially vulnerable countries the hardest.

The cost of debt

Low-income countries face their biggest bills for servicing foreign debts in 25 years, with a group of 91 of the world’s poorest countries paying an average of over 16% of government revenues to repay foreign debts in 2023.

The cost of borrowing for counties with C-rated credit scores has skyrocketed by nearly 15% since February 2022, forcing many to refinance already untenable loans with more expensive ones. The resulting debt spiral has forced 62 countries worldwide to spend more on refinancing foreign debt than on health care, and impeded efforts to invest in meeting development targets and adapt to climate change.

The share of emissions contributed by emerging and developing economies is growing. Their successful transition to a green economy is critical to limiting global warming.

The prohibitive borrowing costs offered to low- and middle-income countries are a major barrier to increased private climate investments, which are critical to countries suffering high debt distress, as is the case for 60% of low-income countries.

“Developing countries do not have the space on their balance sheets for the debt required even if they wished to finance [the green transition] themselves,” Advinash Persaud, a key advisor to Barbados’ Prime Minister Mia Mottley argued in a recent paper. “Recall that developing countries start from high debt levels, worsened by the pandemic, the food and fuel crisis following the Russian–Ukraine conflict, and rising loss and damage from climate change impacts.”

Building a solar field, wind farm or flood barrier in Barbados or Pakistan can incur interest rates two to three times higher than a similar project in Belgium or Germany. Persaud notes that to build a comparable solar farm, annual borrowing costs in the EU sit at an average of 4%, compared to 10.6% in developing countries. As a result of the high cost of capital, only 14% of green investment in developing countries is funded by private finance, compared to 81% in developed countries.

Europe and North America have emitted over 70% of global greenhouses gases over the past 270 years, nearly exhausting the world’s carbon budget.

“The cause of this huge spread is not project-specific risk. A solar farm is no riskier in India than Germany,” Martin Wolf, chief economics editor of the Financial Times wrote in his analysis of Persaud’s report. “More than all of the risk premium represents market estimates of macroeconomic (specifically, currency and default) risks.”

In short, off-base macroeconomic considerations are pricing private capital out of investing in the green transition of the countries most in need of funding.

“Private investors are leaving money on the table,” wrote Persaud. “But even more significant are the far greater social gains from saving the planet and boosting green growth in developing countries that are being left alongside.”

One solution proposed by Mottley is for the IMF and World Bank to provide cheap loans for climate projects. But until the spectre of growing debt and borrowing costs in low- and middle-income countries is tackled, other measures risk being limited to band-aid solutions.

“If we don’t change our institutions, the world will remain the same,” Brazilian president Luiz Inácio Lula da Silva said in his closing remarks amid parting shots at the IMF and World Bank. “The rich will go on being rich, and the poor will go on being poor.”

Image Credits: Markus Spiske/ Unsplash.

Gavi was one of the key pillars of the global COVID-19 vaccine platform, COVAX.

Six weeks before its new CEO was due to assume office, global vaccine alliance Gavi has announced that Dr Muhammad Pate is no longer available for the position.

The appointment of Pate, a former Nigerian health minister, was announced in February following a meeting of the Gavi board. He was to replace current CEO Dr Seth Berkley, who has led the alliance for the past 12 years and is stepping down in August.

However, in a short statement on Monday, Gavi said that its board had appointed Chief Operating Officer David Marlow as interim CEO, following communication from Pate that he will not be able to join Gavi. 

“Dr Pate informed the Gavi Board Chair and Vice Chair that he has taken an incredibly difficult decision to accept a request to return and contribute to his home country, Nigeria. Gavi fully respects the decision and wishes Dr Pate the very best for the future,” said Gavi.

Gavi was unable to tell Health Policy Watch what position Pate would be assuming in Nigeria. However, the Harvard-based Pate has been active in promoting primary healthcare and was well-respected as the country’s health minister between 2011 and 2013.

The announcement came as the Gavi board was meeting this week in Geneva, amidst a Reuters report that a $2.6 billion surplus remains to be spent in COVAX, the WHO co-sponsored COVID-19 vaccine platform that Gavi co-operdinates alongside the Coalition for Epidemic Preparedness Innovations (CEPI) and the World Health Organization (WHO).

While around a quarter of the funds is likely to go towards COVID-19 vaccination programmes, big decisions need to be made about whether some of the money should be poured into COVID vaccine distribution, pandemic preparedness, and bolstering vaccine production capacity in Africa.

“These are COVAX [Advanced Market Commitment] funds which have been donated to Gavi so the decision on how to spend them is ultimately for the Gavi Board and donors to make,” a CEPI spokesperson told Health Policy Watch.

The Gavi COVAX AMC is the innovative financing instrument that supported the participation of 92 low- and middle-income economies in the COVAX Facility.

“Our understanding is that no decision has been made to repurpose the COVAX AMC funds as yet,” added the CEPI spokesperson.

Even though the WHO has declared that COVID-19 no longer is a public health emergency of international concern, thereby acknowledging that the worst and most deadly phase of the pandemic is over, it is important to recognize that we will all be living with COVID-19 and its effects for a long time to come so it is prudent to remain prepared to respond quickly should the COVID-19 situation deteriorate.

“One of the key learnings from the COVID-19 pandemic is that predictable and sustainable end-to-end financing and flexible surge financing – including for R&D and manufacturing – that is readily available in the event of a new outbreak with pandemic potential are key to enabling equitable access to vaccines and other medical countermeasures.

“CEPI is advocating for such financing mechanisms to be established through our engagement with the Pandemic Accord process and the G20 and G7, and we would welcome leftover COVAX funds contributing towards them if the Gavi Board and donors chose to pursue that option.”

Gavi is the biggest vaccine procurement group in the world and is currently responsible for vaccinating almost half the world’s children.  It had not responded to queries about the COVAX surplus funds at the time of publication.

UN Special Rapporteur on the right to health, Dr Tlaleng Mofokeng submits her report on digital health to the UN Human Rights Council (HRC)

Real challenges exist in improving human rights within the digital world of health, according to the UN Special Rapporteur on the right to health, Dr Tlaleng Mofokeng, addressing a UN Human Rights Council (HRC) side event on Friday. 

Shortly after submitting her report on “Digital innovation, technologies and the right to health” to the HRC, Mofokeng said: “We will need to ensure that rights holders know their rights. They understand that digital technologies are not just a safe space.”

The COVID-19 pandemic brought to the fore the use of digital systems and artificial intelligence in healthcare. For many, health care was only provided through online appointments with health professionals. 

Meanwhile, the use of the track-and-trace applications used by many governments worldwide raised legal and ethical questions about people’s private and personal human rights. 

Due to the speed at which the pandemic hit, new rules were often introduced speedily, without the necessary guarantees to protect human rights that other regular frameworks would include. 

The Special Rapporteur’s report analysed the impact of digital technologies on privacy and data protection, and these issues were brought up several times during Friday’s event. 

Allan Maleche, KELIN Executive Director; Timothy Wafula Makokha, KELIN; Timothy Fish Hodgson, ICJ (Africa); Dr Tlaleng Mofokeng, UN Special Rapporteur on the Right to Health; Joyce Ouma, Y+ Global; Dr Mandeep Dhaliwal, UNDP.

“Companies such as Facebook have been quietly amassing health data for years,” Mandeep Dhaliwal, director at the HIV and Health Group, Bureau of Policy and Programme Support, United Nations Development Programme, stated. “Now is the time to make sure that we put that on the table so that people understand that they own their data. That, for me, is fundamental to the rights-based approach to this.”

Timothy Fish Hodgson, a legal advisor on economic, social, and cultural rights at the International Commission of Jurists (ICJ), agreed, telling the audience, “The issue here is that big corporations that are operating in the space of technology and on technological platforms have control over what we do and do not share all over the world. They need to be held responsible.

“To regulate these companies is very difficult for any country because they operate on a global scale, and we need to improve that. Secondly, we need to make very clear specific guidelines for these companies.”

Aside from corporate access to private health data, a second central area of concern related to the impact of growing digital use in countries, particularly in the Global South, where medical data could help perpetuate racism, sexism, or other forms of discrimination – such as countries where abortion is illegal or LGBTQ+ rights are infringed upon. 

One example explained how a woman who approaches a doctor about abortion in a state where abortion is criminalised may risk repercussions for herself and her doctor unless safeguards protecting her right to privacy are maintained. 

Documentation and criminalisation

“There is a direct line between documentation and criminalisation of marginalised groups all around the world, which needs to be taken seriously in this process,” Fish Hodgson said. 

The report concludes with 23 recommendations for the HRC, stating, “Vulnerable groups who face multiple forms of discrimination and oppression in some cases lack access to digital technology and face criminalization, stigmatization, and state surveillance.”

“If we are not thinking properly and thinking through, we run the risk of actually further marginalizing people because the issues of privacy data breaches are heightened,” Mofokeng said.

“Some states have used data searches on your phone, which leave a digital footprint. They can then go and ask the police to trace your search history or retrieve your search history. If you find that it is related to abortion or contraception, they may charge you, and you may end up in prison.”

Mofokeng’s report reiterates the need for state actors to ensure their responsibilities are fulfilled, affirming: “States must embed human rights principles of equality, non-discrimination, participation, transparency and accountability in implementation, in order to meet their obligations to respect, protect and fulfil the right to health in relation to digital innovation and technologies.”

Joyce Ouma, Advocacy and Campaigns Officer at the Global Network of Young People living with HIV (Y+ Global), was optimistic about digital healthcare. 

“Digital technologies and digital health are bringing us closer to Universal Health Coverage. They are bringing us closer to self-care, to taking self-care where we, as young people, can take control of our own lives and our own health,” said Ouma.

As the report maintains, digital innovation and technologies can be an asset when used appropriately to realize the right to health. However, it is up to the HRC to implement the Special Rappoteur’s recommendations as best they can and ensure states and companies protect the rights of all. 

The event was organized by the Kenya Legal and Ethical Issues Network on HIV and AIDS (KELIN) in collaboration with the Permanent Mission of Brazil in Geneva, the Permanent Mission of the Federal Republic of Germany in Geneva, Global Network of People Living with HIV (GNP+), Privacy International, STOPAIDS, the Global Health Centre of the Graduate Institute, International Commission of Jurists (Africa), the Global Governance Centre at Geneva Graduate Institute, and the Centre for Interdisciplinary Methodologies at University of Warwick.

 

United Nations member states meet in New York on Monday and Tuesday (26-27 June) to discuss the latest draft of the Political Declaration on Pandemic Prevention, Preparedness, and Response, ahead of the high-level meeting in September.

The 58-page behemoth compilation draft sent to member states this week is a mass of red, indicating country additions and edits to the zero draft.

Notable are new clauses on the impact of COVID-19, and the inclusion of more references to climate change and the sustainable development goals.

But the mass of contradictory red text on a number of contentious issues, including research and development for vaccines and medicines, indicates that the negotiations have some way to go before consensus is achieved.

Extract from the Political Declaration on HLM on pandemics (compilation draft 1)

Multilateral mechanisms

More attention is also directed a developing “adequately funded multilateral response mechanisms” to address future pandemics.

One clause calls for the UN to “establish, as soon as possible, a mechanism for a coordinated and powerful response in the event of future pandemics”.

Norway wants the WHO to host “an accountable multi-stakeholder coordination mechanism for pandemic-related medical countermeasures” that is “ready when pandemic emergencies hit” but can be scaled back to “essential operational coordination capacity in inter-pandemic periods”.

The EU wants an “interim coordination mechanism for medical countermeasures” that builds on the ACT-Accelerator model to feed into the pandemic accord negotiations. This “will be the legal underpinning for a permanent medical countermeasures platform, and will be adjusted to the outcomes” of those negotiations.

In a new section on global governance, Costa Rica, Canada, Australia, New Zealand (CANZ) and the EU all call for independent monitoring of countries’ implementation of pandemic governance obligations.

In another new section headed “scientific research and development”, the EU wants a reference to “promoting” innovative incentives removed, along with the deletion of R&D “financing mechanisms” for vaccines, therapeutics, diagnostics and other health technologies.

Meanwhile, the US encourages the development of “voluntary patent pools” to develop pandemic products. 

Tight process

June and July are crunch times for the political declaration negotiations. The deadline for the revised text after negotiations on 26-27 June is 30 June.

The third reading of the declaration is set for 5-6 July, with the final reading on 24-25 July.

On 26 July, the final text will be placed under “silence procedure”. This refers to the period at the end of negotiations when tentative agreement has been reached, but delegations may need to get final approval from their governments. 

The final resolution will be debated at the high-level meeting on 20 September.

Image Credits: Wikimedia Commons.

French Health Minister François Braun (left) at an event to introduce HIIP.

Three multilateral development banks and the World Health Organization (WHO) announced the launch of an investment platform on Thursday aimed at supporting low and middle-income countries to build their primary healthcare (PHC) services via grants and concessional loans.

PHC is widely recognised as the most effective way to improve health and well-being, and the recent World Health Assembly recognised it as the driver of universal health coverage, one of the United Nations Sustainable Development Goals (SDGs).

The Health Impact Investment Platform (HIIP), launched during the Summit for a New Global Financing Pact in Paris, will make an initial €1.5 billion available to LICs and LMICs in concessional loans and grants to expand the reach and scope of their PHC services.

HIIP’s founding members are the African Development Bank (AfDB), European Investment Bank (EIB), Islamic Development Bank (IsDB) and WHO. The Inter-American Development Bank (IDB) is also considering joining this partnership, which would extend this initiative to Latin America and the Caribbean region.

“Around 90% of essential health services can be delivered through PHC – on the ground, in communities, via health professionals, doctors and nurses, in local clinics. The broad spectrum of services that PHC provides can promote health and prevent disease, avoid and delay the need for more costly secondary and tertiary services, and deliver rehabilitation,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus at the launch in Paris.

Dr Tedros and African Development Bank Group President Dr Akinwumi Adesina

WHO will act as the platform’s policy coordinator, ensuring the alignment of financing decisions with national health priorities and strategies. HIIP’s secretariat will support governments to develop national health and prioritize PHC investment plans. 

“The COVID-19 pandemic showed significant gaps in health systems around the world, and this is particularly true in primary healthcare,” French Health Minister François Braun told the launch.

“Our world urgently needs a more coordinated financing approach, which bridges the gap between health system investment needs and the challenge of domestic funding.”

European Investment Bank president Dr Werner Hoyer said the platform will “ensure countries in need are better able to build resilient primary health care services that can withstand the shocks of future health crises, and safeguard communities and economies for the future.” 

“The platform will facilitate access to crucial international financing for the most vulnerable. It is a concrete deliverable of President Macron’s call to increase international financial solidarity with the Global South,” he added.

European Investment Bank president Dr Werner Hoyer

The new platform builds on experience gained during the pandemic when countries worked with multilateral organizations and development banks to strengthen their health systems. 

For example, WHO, the EIB and the European Commission worked closely with Angola, Ethiopia and Rwanda to strengthen their health systems. These interventions mobilized technical assistance, grants and investments with advantageous terms to build up PHC.

Rwandan Prime Minister Édouard Ngirente said that his country had worked with several partners for over a decade to build its PHC, resulting in improved life expectancy and other health indicators.

“We believe in partnerships. You can’t build your health system alone,” Ngirente stressed.

African Development Bank Group President Dr Akinwumi Adesina said the bank “will work with countries individually to identify gaps in national health systems, design interventions and investment strategies, find funding, implement projects and monitor their impact”.

European Union offices in Brussels.

The European Union’s proposals to strengthen the pharmaceutical ecosystem are not ambitious enough to address health inequities

The recent meeting of the European Union’s (EU) Employment, Social Policy, Health and Consumer Affairs Council on 13 June, was an opportunity for Health Ministers make proposals to  strengthen the pharmaceutical ecosystem in support of competitiveness and equitable access to medicines. 

The discussion resulted from the Commission’s recently released proposal for the revision of pharmaceutical legislation.

The COVID-19 crisis showed that there are many issues to be resolved regarding the accessibility and availability of lifesaving medicines and the need for effective incentives to produce medicines that truly respond to medical needs, particularly during global public health emergencies.

While it is challenging to improve the pharmaceutical legislation and address the concerns of different stakeholders,  we urge the EU to do better. 

The pharmaceutical package should take into account the impact of quality service provision, make clear the most suitable drugs for particular patients, and enhance inter-agency cooperation – not only at EU-national level, but also within the EU (for example, Directorates General for Trade, International Partnerships, Health Emergency Preparedness and Response Authority, European Centre for Disease Prevention and Control, European Health and Digital Executive Agency).

New measures should be created to control and survey the modification of medicines that may extend patent protection inappropriately. Pharmaceutical companies must prove that the modifications they make are bringing additional value to the patients versus simply extending patents to prevent access to cheaper versions of their drugs.

We also recommend more transparency in R&D-related costs to bring benefits for health use and imply innovation, allowing a better understanding of the medicines landscape and tracking needs overall. 

The pay and bonuses of pharmaceutical company CEOs should also be directly linked to the impact on positive public health outcomes and access to medicines, especially in developing countries.

Pandemic products as public good

 Recognizing pandemic-related products as a public good during health emergencies and limiting the profit margins is the logical step to improve responses to crises.  It should become binding, not only in the pharmaceutical package, but also in the future pandemic accord.

In addition, the legislation under negotiation should bring more equity among EU member states by harmonizing marketing approvals and distribution of new products in all national markets. 

Finding the balance between national, private, and patients’ interests is hard, and taking sides may be inevitable. We strongly believe that the EU must, first and foremost, support the population, the community, and the patients – all who bear the brunt of a lack of access to affordable medicines.

The revision of the pharmaceutical legislation is also an opportunity to reflect on where we want our health systems to be in the future and the kind of care we can provide to people. 

Do we want to continue to incentivise the high salaries and profits for big pharmaceutical companies, with $19,2 million pay packages, while many struggle to access basic medicines and other health commodities? 

Can we allow companies to make $5.6 billion in sales while still in the pandemic period, while countries are operating in emergency mode and struggling to keep their respective responses going?

Customers queuing in Toulouse, France, as part of social distancing measures taken to reduce crowding in supermarkets during the COVID-19 pandemic.

Emerging divisions between EU members

Since the publication of the revised pharmaceutical legislation on 26 April,  divisions between member states are emerging. 

One group (Austria, Estonia, Hungary, the Netherlands, Poland, Slovakia) is pushing for more flexibility for the generic market and requiring new products to respond to unmet medical needs allowing profits from incentives. 

The other group (Germany, Italy, Denmark) is pushing for more protection of private industries, including a more predictable regulatory framework, voluntary commitments for companies, and the safeguarding of intellectual property rights.

The revision of the World Trade Organization (WTO) Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) is also closely linked with equal access to medicines and the revision of pharmaceutical legislation. 

The EU is strongly promoting its own vision of voluntary and compulsory licensing, leading to complicated negotiations at the WTO. Several patient advocacy associations have pointed to the need for revisions to TRIPS Agreement since voluntary licenses are often difficult to implement, have limited scope of distribution, exclude many middle-income countries, and sometimes do not even allow the sales of active pharmaceutical ingredients. 

As authorities leave the market unregulated, the profit-seeking nature of private companies often makes it  difficult access to lifesaving medicines, including for treatable conditions such as HIV and hepatitis C.

Patent evergreening, whereby pharmaceutical companies are able to extend patents by making small changes to the formulations that do not constitute a major innovation, and re-patenting them as new and improved drugs, also needs to be addressed by the EU.

 Patent evergreening creates barriers to affordable, generic medicines and keeps them from reaching low- and middle-income countries. It also carries societal costs and often deviates research from truly necessary medical needs, keeping costs higher and undermining access.

There is a danger that even the innovative incentives to produce medicines responding to unmet medical needs, such as exclusivity vouchers, risk the distortion and monopolization of markets of public interest. One year of market exclusivity is estimated to cost  around €500 million by the European Commission.

We echo the sentiments of other like-minded advocates like Dimitri Eynikel of Médecins Sans Frontières who states, “We urge EU member states and the European Parliament to not forsake this opportunity to legally safeguard public health interests and remain vigilant up until this new proposal is adopted as legislation: there must be no watering down of the provisions on transparency and compulsory licenses, and if access to affordable medicines in the EU is a priority, any inclusion of transferable exclusivity vouchers should be seriously challenged.” 

Only by taking responsibility and accepting accountability for people’s health now can the EU better prepare for future health crises and establish an innovative, fair, and inclusive health system that works for all.

AIDS Healthcare Foundation Europe is the European branch of world’s largest non-governmental HIV service provider, AIDS Healthcare Foundation (AHF). AHF Europe is active in nine European countries: Estonia, Georgia, Lithuania, Poland, Ukraine, UK, the Netherlands, Greece and Portugal;  supporting HIV/AIDS prevention, testing and treatment services. AHF Europe advocates for inclusive health care services, equal access to medicine, comprehensive prevention initiatives and multisectoral approach to health at national, regional and international levels.  For further information, contact Indre Karciauskaite, Europe Policy Director, indre.karciauskaite@ahf.org 

Image Credits: Carl Campbell/ Unsplash, Wikimedia Commons: Alteo31300.

The World Health Organization (WHO) has published its first global research agenda to combat antimicrobial resistance (AMR) that outlines 40 research priorities.

An estimated 4.95 million deaths were associated with bacterial AMR in 2019. AMR occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to antimicrobial medicines making infections harder to treat and increasing the risk of disease spread, severe illness and death.

Drug-resistant tuberculosis is particularly pervasive, with an estimated 450 000 new cases of rifampicin- and multidrug-resistant tuberculosis in 2021.

The research agenda was developed after a review of over 3,000 documents published over the past decade and is divided into prevention, diagnosis, treatment and care, as well as cross-cutting issues. 

Prevention includes basic issues such as improved access to clean water and sanitation. Diagnosis identifies a long list of tests needed to fast-track the identification of drug resistance. Treatment and care focus on encouraging stewardship of antibiotics by pharmacists and health workers.

“To help preserve antimicrobials and save lives and livelihoods, this research agenda is a crucial tool for researchers and funders to prioritize research questions, and promptly and efficiently generate evidence that informs policy,” said Dr Hanan Balkhy, WHO Assistant Director-General for AMR. 

“This first research agenda from WHO will provide the world’s AMR researchers and funders with the most important topics to focus on and give the world its best chance to combat AMR,” added Dr Silvia Bertagnolio, Head of the WHO AMR Division.

Heat wave warning from Indian’s Metereological Department

PUNE, India – Close to 200 people have died in Central India as a result of a severe heat wave in the region with temperatures in the range of 40-43 degrees Celsius, according to India’s Meteorological Department. 

While there has been no official confirmation of the death toll, Associated Press has estimated that close to 200 people have died so far in the states of Uttar Pradesh and Bihar alone. The heat wave is affecting seven states.

Heat-related deaths are notoriously hard to pin down and overwhelmed hospitals are often not able to dedicate the time to clinically establish it in the middle of a heat wave, which gives authorities the alibi to easily downplay the numbers.

Heatwave map shows temperatures in Central India, 21 June 2023.

Earlier, heat wave warnings were also issued for the months of April and May. Last year, large parts of South Asia experienced the hottest March in 132 years. This was unusual as April and May are usually the hottest months India. 

The current heatwave is also unusual for June when monsoon showers usually cool down the subcontinent. Human-caused climate change doubled the likelihood of the three-day extreme heat wave over India’s most populous state, Uttar Pradesh, between 14- 16 June, according to a new analysis by researchers at climate communication group Climate Central.

With climate change, such anomalies are expected to rise, according to scientists, but heat-related deaths are easily preventable, they say.

Early warning 

India has adequate early warning system in place, Abhiyant Tiwari, the lead of health and climate resilience at NRDC-India, told Health Policy Watch. His organisation works with governments on improving climate resiliency. 

Heat-related deaths can be prevented by improving coordination between weather and city officials, said Tiwari, something his team helped set up in Ahmedabad city in 2013, making it the first city in South Asia to have a heat action plan in place that remains functional to date. 

India’s weather department already releases alerts ahead of heat waves and other extreme weather events. In Ahmedabad, a local officer was charged with coordinating with the weather department and other health and civic officials to kickstart a response in the event of a heat wave. 

Such plans have worked to drastically reduce deaths by simply warning the communities to stay indoors ahead of time, and asking them to keep hydrated. Hospitals too are warned to brace up for additional patients.

“The best part is that it is a low-hanging fruit. Heat-related deaths are easily averted and there are no major costs involved at least in implementing the early warning systems. I’m not talking about the long-term mitigation measures, but at least these short-term measures during summer which can save lives by proper messaging, proper preparedness, proper response,” Tiwari said.

In the past few days, both day and night time temperatures have been high in Central India leading to a high “heat load,” he said. As average global temperatures continue to rise, night-time heat waves are set to worsen, according to studies.

India’s health minister Dr Mansukh Mandaviya interacts with senior officers of the seven states affected by severe heat waves.

 

India’s central government has advised affected states to ensure uninterrupted electricity supply and improve the collection of data from the ground on heat wave deaths to improve response, as hours’ long power cuts are still common in the country’s rural areas.

Climate change worsening heat waves

Summers in India are always hot and a time when schools shut down for the annual break. But rising global temperatures linked to the changing climate have significantly worsened the heat, according to scientists.   

An analysis released in May this year by a team of international climate scientists at the  World Weather Attribution initiative, based at Imperial College, London, found that climate change had made the April heat wave over parts of India, Bangladesh, Laos and Thailand 30 times more likely.

“We see again and again that climate change dramatically increases the frequency and intensity of heat waves, one of the deadliest weather events that exist. Our most recent WWA study has shown that this has been recognized in India, but the implementation of heat action plans is slow. It needs to be an absolute priority adaptation action everywhere,” said Dr Friederike Otto, a researcher at Imperial College London and co-lead of World Weather Attribution (WWA).

While many Indian cities and states have developed heat wave action plans in recent years, their implementation remains weak. This week the country’s central government asked all states to develop a plan with the summers increasingly turning deadly.

Images from news reports from the ground in Central India showed collapsed old and young people being carried to the hospital by family members, overcrowded hospital beds, and family member performing the last rites of the dead.

High temperatures also mean increased demand for electricity and higher carbon emissions as roughly half of India’s electricity is primarily generated by burning coal, despite the ongoing attempts to scale up access to solar electricity.

The air pollution connection

India’s toxic air is also making matters worse. High temperatures generally also worsen air pollution levels.

“During heat waves, levels of ozone, and in some cases, production of particulate matter pollution can increase,” said Pallavi Pant, who is the head of global health at the Boston-based Health Effects Institute.

Ozone pollution can damage tissues of the respiratory tract and worsen asthma symptoms, while persistent exposure to particulate matter can cause strokes, heart disease, lung disease, lower respiratory diseases (such as pneumonia), and cancer, according to the UN Environment Programme. High levels of fine particles also contribute to other illnesses, like diabetes, can hinder cognitive development in children and also cause mental health problems.

“This problem is also not unique to India. Cities and regions around the world are experiencing a higher intensity of heat waves and deterioration of air quality.  In California, one study found that exposure to high heat and air pollution at the same time led to nearly three times higher risk of death compared to air pollution or heat alone,” Pant said.   

High heat and air pollution are linked to respiratory diseases and together, they can increase the risk of poor health, especially for people living with chronic lung or heart diseases. In some cases, exposure to high heat and pollution can also lead to death. Older people and outdoor workers are particularly vulnerable.

Central India is already home to a majority of the world’s most polluted cities and an analysis from Delhi by the Centre for Science and Environment confirmed that ozone pollution spikes in summers.

Ozone exposure is already high across India, according to the State of the Global Air report. 

India has one of the highest levels of ozone pollution in the world.

While short-term measures like heat wave plans can reduce deaths, scientists are clear that unless global carbon emissions are brought down and fossil fuels are phased out, such extreme weather events are only going to get worse. 

But on that front, there isn’t enough largescale movement yet and the world is currently headed to an average global temperature rise of 2.8 degrees Celsius by the turn of the century, according to the United Nations. 

Marketing claims made by commercial formula milk companies (brand names have been changed).

As representatives of 130 countries meet in Geneva this week to discuss how to counteract the tactics of baby formula manufacturers, the World Health Organization (WHO) has urged member states to update their laws to prevent the marketing of baby formula in the wake of increasing industry sophistication.  

The meeting is aimed at beefing up the International Code of Marketing of Breastmilk Substitutes, adopted in 1981 as a means to encourage exclusive breastfeeding, which was being undermined by the aggressive promotion of baby formula.

Since the code was adopted, almost three-quarters of countries have enacted legislation that puts in place at least some of the code’s provisions. As a result, exclusive breastfeeding feeding has increased globally by 10%, reaching 48% of children under six months – the highest level since the 1980s, said WHO Director-General Dr Tedros Adhanom Ghebreyesus. 

The International Code of Marketing of Breastmilk Substitutes is making an impact

“But little progress has been made in high-income countries where the code has not been made into effective legislation and, as a result, exclusive breastfeeding rates are stagnating,” Tedros told a media briefing on Wednesday.

“Manufacturers of breast milk substitutes are also using increasingly sophisticated marketing tactics, including targeted ads on pregnant mothers’ mobile phones, clandestine participation in online baby clips, or coaxing mothers to market formula to one another,” he added.

High-income countries have “the lowest rates of exclusive breastfeeding in children under six months”, according to Dr Francesco Branca, WHO Director of Nutrition.

Meanwhile, only 32 countries are fully compliant with the code and many others needed to update their legislation to address the “new forms of marketing”, including digital outreach and donations to professional societies, added Branca.

“Definitely WHO is recommending that member states… have much greater and stricter legislation because we have seen that that is associated with increased rates of breastfeeding,” added Branca, commending countries in South Asia and Africa for “producing legislation which is closest to the implementation of the code”. 

Behind closed doors

But two days of the three-day talks are taking place behind closed doors at WHO’s Geneva headquarters. Media access to the proceedings has been limited to the opening statements  – with no virtual press access granted even to that portion.

Asked why the forum was closed to the public, and only open to Geneva media, WHO said only: “The meeting is really geared towards countries, as we hope to provide an opportunity for member states to make plans on how they can improve the implementation of the code.” 

Rates of exclusive breastfeeding are 20% higher in countries that have legislation substantially aligned with the code, noted WHO’s Director General Dr Tedros Adhanom Ghebreyesus at the start of the meeting.

Continuation of breastfeeding in the first two years of life is more than twice as high when the legislation is substantially aligned with the code. “Let’s put a stop to the commercialization of our children’s health. It’s time to end exploitative marketing,” said the WHO Director General. 

“Inadequate breastfeeding increases the risks of childhood obesity, sudden, unexplained unexplained infant death, leukaemia and other cancers,” Tedros told the media briefing. “WHO recommends exclusive breastfeeding for the first six months of life and continued breastfeeding for two years or beyond.”

A Nestle advertisement from 1911 undermines breastfeeding.

The World Health Assembly (WHA) adopted the code in 1981, when global awareness about the health impacts of infant formula reliance, particularly in developing countries with unsafe water, first emerged. While there has been “clear progress” in the 42 years since it was adopted, formula milk manufacturing companies have sharpened their marketing tools, using “exploitative” practices on new digital platforms to market milk formula, according to WHO. 

A report released in April 2022 revealed what WHO described as the “shocking” extent of such practices, used by the baby formula industry, estimated to earn some $55 billion a year. 

The report detailed how formula milk companies are paying social media platforms and influencers to access and influence pregnant women and new mothers using personalized social media content that is often not recognizable as advertising. 

Through tools like apps, virtual support groups or ‘baby clubs’, and with the support of paid social media influencers, formula milk companies offer women competitions, advice forums or services – buying and collecting their personal data to further hone down their promotions. 

The report summarizes findings of research that sampled and analyzed four million social media posts about infant feeding published between January and June 2021, reaching some  2.47 billion people.

Meanwhile, experts said last year said that infant formula companies have “pathologised” normal baby behaviour to promote their products, and there should be “an international, legal treaty” to prevent their marketing, and that political lobbying by milk formula companies to influence public policy should be sharply curtailed.

These comments were contained in a three-part series published in The Lancet, in which the authors said that formula milk companies “exploit parents’ emotions and manipulate scientific information to generate sales at the expense of the health and rights of families, women, and children”.

“The sale of commercial milk formula is a multi-billion-dollar industry which uses political lobbying alongside a sophisticated and highly effective marketing playbook to turn the care and concern of parents and caregivers into a business opportunity. It is time for this to end,” says series co-author, Professor Nigel Rollins from WHO’s Department of Maternal, Newborn, Child and Adolescent Health.

Image Credits: WHO.

The climate crisis is creating a new generation of refugees.

There are more displaced people in the world today than at any other time in history. A record 110 million people have been forcibly displaced worldwide as of May 2023. Last year, 19.1 million people fled their homes as conflicts, climate shocks and hunger swept across the world, the largest single year increase ever recorded. 

Russia’s full-scale invasion of Ukraine caused the largest forced movement of people since World War II – the conflict that spurred the ratification of the UN Refugee convention 70 years ago. 

Record droughts in the Horn of Africa, a renewed war in Sudan and the growing severity and frequency of natural disasters have only added to the growing list of causes for the ever-growing surge. 

“It’s quite an indictment on the state of our world,” said UN Refugee agency head Filippo Grandi. “Unfortunately, in today’s divided world, long-term solutions for people forced to flee remain pitifully scarce.”

The number of refugees has more than doubled in the past decade, rising to 35 million from 15 million in 2011. Seven in ten refugees flee across just a single border to neighboring countries in hopes of eventually returning home. More than half of refugees come from just three countries: Syria, Ukraine and Afghanistan.

“The prevailing rhetoric is still that all the refugees go to rich countries,” said Grandi. “This is actually wrong. It’s quite the opposite.”

Around 76% of forcibly displaced people are hosted in low- and middle-income countries, while 70% of refugees are hosted in countries neighbouring their country of origin. 

Turkey is home to the most refugees in the world. It hosts 3.8 million people, the majority of whom are Syrians who fled the civil war. Iran is second, with 3.4 million refugees, mostly Afghans. Columbia, Germany and Pakistan round out of the top five. 

“These are not numbers on a page,” said UN Secretary General Antonio Guterres, who served as the UN High Commissioner for Refugees for a decade before taking over leadership of the UN. “These are individual women, children, and men making difficult journeys – often facing violence, exploitation, discrimination and abuse. Four in ten people forced to flee are children. They deserve a home, a childhood and a future just as much as anyone else.”

The week leading up to World Refugee Day, celebrated on June 20 every year, served as a stirring reminder of the dangers faced by people who leave their countries to find safety for themselves and their families.

Last Tuesday, on what would have been the dawn of World Refugee Day had it been a week later, the Greek coastguard was notified of a vessel carrying hundreds of migrants en route to Italy. Dozens of pleas for help from the dilapidated shipping trawler were recorded by humanitarian search-and-rescue groups over the ensuing hours. 

The ship sank mere meters from a coast guard vessel 18 hours after authorities were made aware of its existence. The wreck claimed the lives of up to 700 men, women and children on board. 

Survivors say as many as 100 children may have been in the hold of the ship when it sank. Yiva Johansson, the EU Commissioner for Home Affairs, said the incident may be “the most tragic ever in the Mediterranean”. Greek officials continue to contest the chain of events that led to the disaster. 

The Mediterranean Sea, despite its proximity to the European Union, the world’s wealthiest economic bloc, is the deadliest route for refugees in the world. The International Organization for Migration (IOM) has recorded over 20,000 deaths on the route since 2014, and another 7,000 people reported missing along the route have never been found.

After years of innumerable tragic headlines reaching the notification screens of people around the world, observers worry the extent of their plight has become normalized. 

“I am struck by the alarming level of tolerance to serious human rights violations against refugees, asylum seekers and migrants that has developed across Europe,” said Dunja Mijatović, the Commissioner for Human Rights of the Council of Europe. “Reports of human rights violations against refugees, asylum seekers and migrants are now so frequent that they hardly register in the public consciousness.” 

António Vitorino, who leads the International Organization for Migration that runs the Missing Migrants Project, echoed similar concerns: “I fear that these deaths have been normalized.”

Climate threatens to force unprecedented numbers of people to seek safer ground

If the world can limit warming to 1.5C, the number of people living outside the livable “climate niche” will be reduced by 80% compared to the current 2.7C trajectory.

Weather-related disasters triggered 32.6 million internal displacements in 2022, the highest number in a decade and 41% over the annual average of the last ten years. Unpredictable rainfall and intense droughts across Southeast Asia have already led to over eight million people moving to more hospitable climates in the Middle East, Europe and North America, according to the World Bank. 

Millions have already been made climate refugees by the current 1.2C in global temperatures. In Bangladesh, 10 million people have fled their homes as a result of flooding and drought. An estimated 2,000 people move to the capital, Dhaka, every day – 70% of them due to weather-related events. But as migrants move to Dhaka in search of safer ground, the city itself is sinking, threatening the livelihoods of its 168 million residents. 

And with the world on track for 2.7C of global heating, these numbers may be just a drop in the bucket by 2050. As the IPCC projects worse fires, longer droughts, and increased flooding, the World Bank estimates 143 million people could be climate migrants by 2050 – four times the record-setting number of refugees in the world today. And some scientific projections make the World Bank estimate look like a best-case scenario. 

If the world continues to warm at the current pace, two billion people will be driven out of the “climate niche” humans have thrived in for thousands of years. The extreme temperatures and weather patterns that result from the warming could lead up to one billion people to leave their homes in search of safer weather, a recent study in Nature Sustainability found. 

An earlier study, published in the journal Proceedings of the National Academy of Sciences in 2020, estimated that 19% of land currently inhabited by people could turn into uninhabitable hot zones by 2070, placing one in every three people in climates that will force them to leave.

The consequences of climate change place people living in conflict-affected and politically fragile regions in particular danger. An estimated 70% of refugees and 80% of internally displaced people today come from countries that are also highly vulnerable to climate change, while 40% of refugees worldwide are hosted in climate vulnerable countries. In 2021, nine in ten refugees who returned home returned to highly climate vulnerable countries. 

“Climate shocks are throwing fuel on the fire of persistent cycles of crisis and displacement,” the UN Refugee Agency told delegates ahead of the UN Climate Summit, COP27, in Egypt last year. “Loss and damage from the impacts of climate change is already a devastating reality for millions of people as climate-fueled crises, food and water insecurity and loss of habitable territory drive new displacement and make life harder for people already uprooted from their homes.”

The Ecological Threat Register, a project run by the Institute for Economics & Peace, estimates that by 2040, more than half of the world’s projected population – 5.4 billion people – will live in countries experiencing water stress. Meanwhile, 3.5 billion people may suffer from food insecurity by 2050, 1.5 billion more than today.

With the prospect of millions of climate refugees on the horizon, the world will need to adjust. Yet for now, the world is moving in the opposite direction. 

“We see pushbacks. We see tougher and tougher immigration or refugee admission rules. We see in many countries a criminalization of immigrants and refugees, blaming them for everything,” said Grandi. “It cannot be just about controlling your borders.

“Leadership is about convincing your public opinion that there are people that deserve international protection.”